Minor Obstetric surgeries

Question 1

Elective surgical abortion

1st trimester

Answer 1

1. Dilation and curettage= scrapes the endometrial tissue using a curette
2. Aspiration abortion is used during the first trimester

Question 2

Elective surgical abortion

2nd trimester

Answer 2

1. Dilation and evacuation= A gynecological procedure that involves dilating the cervix (manually or pharmacologically)

Suctioning the amniotic fluid, and physically removing products of conception, typically with forceps. Referred to as intact dilation and evacuation when the fetus is removed in one piece. Commonly performed after 13 weeks’ gestation for induced procedural abortion or fetal demise. Prophylactic antibiotics decrease the risk of infection.

Question 3

Elective surgical abortion: drugs used to ripen the cervix or methods to dilate ?

Answer 3

1. Medication= prostaglandin analog (misoprostol)
2. Osmotic dilators= placed into cervix, draws water from surrounding then swells allowing view into the cervix (hygyroscopic material in a stick)

Question 4

Caesarean section: types

Answer 4

1. Lowers segment = suprapubic transverse incision (2 cuts: Pfannenstiel incision aka curved, or Joel-Cohen incision)
2. Classical= vertical incision

The Lower segment allows for trial of labour in subsequent pregnancies

Question 5

Caesarean section: indication

Answer 5

1. Foetal/maternal health compromised=foetal distress, placenta praevia, abnormal lie,
2. Emergency= distress, prolonged first stage of labour >12hrs, uterine rupture
3. Elective= pre-eclampsia

Question 6

Caesarean section: advantages vs disadvantages

Answer 6

1. Advantage= safe for baby, and best option if maternal or foetal health is compromised
2. Disadvantage= long recovery process, post op complications

Question 7

Caesarean section: contraindication

Answer 7

No true contraindications

Question 8

Caesarean section: basic steps

Answer 8

• Skin incision above the pubic symphysis.
• Largely blunt penetration through the abdominal muscles, fascia, and peritoneum
• Hysterotomy
• Fetal extraction, cord clamping, and manual placental removal
• Wound closure

Question 9

Caesarean section: complications

Answer 9

1. Maternal= infection, haemorrhage, iatrogenic damage to bladder or other ogans, pain
2. Foetal= Postnatal transient tachypnea of the newborn, Acute respiratory distress syndrome

Question 10

Oulet forceps: what does this mean?

Answer 10

Outlet forceps are used when the babies head is on the pelvic floor

Question 11

Outlet forceps: types

Answer 11

Simpson and Wrigley

Question 12

Vacuum extraction delivery: indication

Answer 12

1. Prolonged 2nd stage of labour
2. Nonreassuring foetal heart rate
3. Maternal fatigue

Question 13

Vacuum extration delivery: where does the cup go on the foetal head?

Answer 13

Sagittal suture at the median flexion point (also known as the pivot point), which is 2 cm anterior to the posterior fontanelle or 6 cm posterior to the anterior fontanelle.

Question 14

Vacuum extraction delivery: contraindication

Answer 14

• Breech or face presentation
• Intracranial haemorrhage

Question 15

Vacuum extraction delivery: foetal complications

Answer 15

• ‘Chignon’, a swelling of the area of scalp that was drawn into the cup
• Scalp laceration
• Cephalohaematoma

Question 16

Vacuum extraction delivery: maternal complication

Answer 16

• Suction of maternal soft tissue
• Lacerations

Question 17

ECV: when do you attempt?

Answer 17

1. 37 weeks, attempt ECV
2. Make sure there is no contraindications such as placenta praevia

Question 18

ECV: method

Answer 18

• Empty bladder
• Give tocolysis ?
• Attempt to rotation in direction of flexion

Question 19

Internal version: method

Answer 19

1. Apply spinal anaesthetic
2. Use aspetic method (sterile gloves and iodine)
3. Insert hand into the vagina to the cervix and once at the opening to the uterus, feel for the leg and pull
4. Deliver in breech
5. Check for placenta etc after delivery and give abx

High risk of uterine rupture, infection etc

Question 20

Vaginal breech: Tzovyanov, Bracht, Mueller, Lovset

Answer 20

1. Tzovyanov=frank breech. Same as Bracht
2. Bracht= frank breech. Allowed to delivery until the umbilicus spontaneously. Grasp the body and keep legs extended by placing thumbs on either thigh and fingers on the back. Then slowly bring that delivered portion to the mother abdomen whilst assisst applies suprapubic pressure.
3. Muller= helps delivery the shoulder, so hold hips rotate slightly and pull down, deliver the anterior shoulder then pull upwards to deliver the posterior
4. Lovset= hold the sacroiliac joint and rotate the back half circle to delivery the impacted shoulder then the opposite direction. Keep downward traction. Posterior arm deliver first

No traction, just holding in 1&2. Keep hands off basically as much

Question 21

ECV: contraindication

Answer 21

1. Placenta praevia
2. Twin pregnancy
3. Scarred uterus
4. Prematurity

Question 22

Breech vaginal delivery: the cardinal movements

Answer 22

1. Engagement
2. Decent
3. Internal rotation of the anterior buttocks
4. Lateral flexion
5. Delivery of trunk
6. Restitution
7. engagement and descent of shoulder
8. Internal rotation of shoulder
9. Lateral flexion
10. Delivery of shoulder
11. then delivery of the head

Question 23

Braxton-Hicks version: what happens?

Answer 23

1. Basically you combine internal version with external version
2. Use need: sufficent mobile uterus, enough dilation and